Healthcare Provider Details

I. General information

NPI: 1457017832
Provider Name (Legal Business Name): ALEXIS BAINGER PT, DPT, CERT. DN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 STATE ROAD 13 N STE 21
FRUIT COVE FL
32259-2824
US

IV. Provider business mailing address

12065 WILLIAMSTOWN DR
JACKSONVILLE FL
32256-0868
US

V. Phone/Fax

Practice location:
  • Phone: 904-239-5715
  • Fax:
Mailing address:
  • Phone: 904-834-0975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT38017
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: